North Dayton

Fairborn

New Carlisle

Springfield

Moraine

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Apply to Buy a Car Online in the Dayton Area - FREE!


We finance all our pre-owned vehicles.  YOU can be APPROVED based on your honesty and the accuracy of the information you provide,
along with your ability to pay.

Your Personal Information: 
Please use the "TAB" key to move between fields.   DO NOT USE the "ENTER" key.

Did you find our site on a search engine?    Yes  No   
If yes, please specify:

Alta Vista  Excite  Hot Bot   Lycos   MSN   AOL   Google   Yahoo  Other search engine

Type of Vehicle I'm Looking For:


Customer Information

Borrower: 

Co-Borrower:  


E-mail: 

Current Street Address: 


City: 
  State:    Zip Code: 

Home Phone: 
  

Work Phone
(include extension if applicable):

Vehicle Information

Purchase Price (How much you'd like to spend)


Cash Down payment
Yes    No
Amount of Cash Down (If available)

Trade-In:    Yes    No
Trade-In Make, Model, Year: 

How much do you still owe on this vehicle? 


Credit Information

How would you rate your Credit?  Excellent   Good   Fair   Poor

Borrower Employment Status:            Co-Borrower Employment Status:
Salaried/Hourly Self Employed  Salaried/Hourly  Self Employed

Borrower Employer:                              Co-Borrower Employer                     
                                
Number of years with Company:          Number of years with Company:
                                                        
Borrower Gross Mo. Income:              Co-Borrower Gross Mo. Income:
                                                 
Monthly Rent or House Payment:

Borrower Monthly Auto Pmts:               Co-Borrower Monthly Auto Pmts:
                                                 
Credit Card
(Min. Mo. Pmt):        Co-Borrower Credit Card (Min. Mo. Pmt):     
                                                 
Other Monthly Debt:
(Child Support, Student Loans. Do not include current house payment, rent or utilities)


Any additional information?  Any credit problems?  Tell us what you'd like to do.  Type in box below:

Thank you  
This form is not to be considered a formal loan application, but the information gathered here will be used to determine our estimate of the borrower's qualification to obtain a vehicle loan.

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Last modified: 07/02/13